Form I-418 Passenger List - Crew List

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
PASSENGER LIST - CREW LIST

OMB Control #: 1651-0103

Prior to arrival in the United States, complete a separate form for a) working crew; and b) passengers and supernumeraries. In addition
to its initial completion, the crew list shall be updated to reflect crew changes and other relevant activity (or lack thereof) until the vessel
departs the United States.
Vessel Name:

Nationality:

Official Number:
Date Sailed from Foreign Port:

Last Foreign Port (Place and Country):
Date of Arrival in U.S.:

Arrival Port:

No. of Crew (including Master):

No. of Passengers:

Agent at Arrival (Name & Address):
Will crew perform longshore work while vessel is in the United States?

YES (Provide applicable INA Section 258 Exemption):

NO

PROPOSED ITINERARY
Next U.S. Port(s)

Arrival Date

PASSENGER LIST

Vessel Agent (Name and Address)

CREW LIST

Page 1 of

List individuals alphabetically. Crew who join the vessel subsequent to its arrival while in the United States must be added to the original
list and the appropriate date recorded in the "Date Joined" column. The "Date Separated" column must be used when a listed crewman
is separated from the vessel while it is in the United States. Any crewman designated as "REFUSED" in the "DHS Use Only" column is
to be detained on the vessel at all times.
Family
Name

First Name &
Initial

Date of
Birth

Nationality/
Document #

Position or
Title

Date
Joined

Date
Separated

(Crew Only)

(Crew Only)

(Crew Only)

RECEIPT FOR CREW LIST (CBP Use Only). I-418 Receipt Number at
right indicates that the U.S. Customs and Border Protection (CBP) has
received the CREW LIST containing the names of all members of crew,
including Master, on board said vessel at time of its arrival.

Inspection Status
(DHS Use Only)
Checked box indicates
subsequent parole.

I-418 Receipt Number (POE - YYMMDD - Badge # - Military Time):

CBP Port of Arrival (address):

SUMMARY OF DEPARTURE
Vessel Agent (at Departure): Following this vessel's departure from the United States, ensure that crew list reflects all crew additions
and separations and is promptly submitted to the U.S. Customs and Border Protection office at the port of departure. Summarize the
departure circumstances by providing the following information:
Agent at Departure (Name & Address):
Date of Departure:

Port of Departure:

Total Added Crew:

Total Separated Crew:

CBP Form I-418 (01/04)

MASTER'S CERTIFICATION
MASTER: Execute the following oath before a U.S. Customs and Border Protection Officer as to all arriving passengers on all vessels
and all departing crew on United States Flag Vessels, and before an CBP Officer authorized to administer oaths as to all departing
passengers on vessels:
I certify that the U.S. Customs and Border Protection baggage declaration requirements have been made known to incoming
passengers; that any required CBP baggage declarations have been or will simultaneously herewith be filed as required by law and
regulation with the proper CBP Officer; and that the responsibilities devolving upon this vessel in connection therewith, if any, have been
or will be discharged as required by law or regulation before the proper CBP Officer. I further certify that there are no steerage
passengers on board this vessel (46 U.S.C. 151-163).
Signature of Master:
CERTIFICATION OF COPY OF CREW LIST OF UNITED STATES FLAG VESSEL
I certify that this is a true copy of the original crew list of the named American vessel, which original crew list is on file in this office.
Given under my hand and seal of office at the customhouse at
on

.

Signature of CBP Officer:
PASSENGER LIST

Vessel Name:

Family
Name

CREW LIST

Page

of

Arrival Port in U.S.:

First Name &
Initial

I-418 Receipt Number (DHS Use Only)

Date of
Birth

Nationality/
Document #

(CONTINUATION)

Arrival Date:

Position or
Title

Date
Joined

Date
Separated

(Crew Only)

(Crew Only)

(Crew Only)

Inspection Status
(DHS Use Only)
Checked box indicates
subsequet parole.

CONTINUED

CBP Form I-418 (01/04)

PASSENGER LIST - CREW LIST
Family
Name

First Name &
Initial

Date of
Birth

Continuation Sheet Page

Nationality/
Document #

Position or
Title

Date
Joined

Date
Separated

(Crew Only)

(Crew Only)

(Crew Only)

of

Inspection Status
(DHS Use Only)
Checked box indicates
subsequet parole.

CBP Form I-418 (01/04)

PASSENGER LIST - CREW LIST
INSTRUCTIONS
ALL NAMES AND OTHER DATA INSCRIBED ON THIS FORM MUST BE IN THE ENGLISH LANGUAGE
PASSENGERS: Deliver one complete alphabetical passenger list, regardless of nationality, to United States Public
Health Service, and three such lists to the United States Customs and Border Protection, on arrival at first port in the
United States.
CREW LIST VISA APPLICATION: Submit form in duplicate to U.S. consular officer, specifying each alien crewman not
in possession of a valid individual visa or lawful resident alien card.
ARRIVING CREW: Deliver one complete alphabetical crew list, regardless of nationality, to United States Public Health
Service, and three such lists to the United States Customs and Border Protection on arrival at first port in the United
States. Where a crewman is a returning resident, show his/her alien registration receipt number where prompted for a
document number.
CHANGES IN CREW: If an alien crewman is separating from the vessel while in the United States (and will not be
returning), discharge authorization must first be obtained from the United States Customs and Border Protection via Form
I-408 (Application to Pay Off or Discharge Alien Crewman) and the appropriate date of separation must be recorded in
the "Date Separated" column of this form for that crew member. If a crew member joins the vessel while in the United
States, add the crewman's name and other requested information at the next available blank line of the list and record the
appropriate date in the "Date Joined" column.
DEPARTING CREW: When the vessel departs the United States, complete the SUMMARY OF DEPARTURE section
and deliver one complete list (whether or not there have been crew changes) to the United States Customs and Border
Protection at the port of departure.

PAPERWORK REDUCTION ACT NOTICE. An agency may not conduct or sponsor an information collection and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms
and instructions that are accurate, can be easily understood and which impose the least possible burden on you to provide us with
the information. Often this is difficult because some immigration laws are very complex. The average time to complete and
process this form is one hour. If you have comments regarding the accuracy of this estimate or suggestions for making this form
simpler, please write to U.S. Customs and Border Protection, Information Services Branch, Washington, DC 20229 and the Office
of Management and Budget, Paperwork Reduction Project, Washington, DC 20503.

CBP Form I-418 (01/04)